Monthly Archives: August 2016

On my way home (by way of Delhi…woe), I have stopped over in the city of Almaty to visit my college friend Freeman, who works for the State Department in Kazakhstan. I know you almost certainly have no idea where Kazakhstan is, and that’s fine. It’s a former Soviet state that shares part of its eastern border with China and its southern border with Kyrgystan and Uzbekistan. Kazakh culture is heavily Russian with a mix of other influences from China and central Asia, and people are predominantly Muslim. There’s also a significant Korean population, and the art and food maintain a lingering fragrance of the old Silk Road. The eastern and southern borders are braced by the upper parts of the Himalayan mountain range that eventually makes its way down through Pakistan, India and Nepal.

That Crazy Russian Alphabet (bonus: Camca = Samosa)

Basically, Kazakhstan is a gorgeous cultural crossroads, surrounded by mountains, where everything is written in that crazy Russian alphabet that looks like English after a rough night.

On the first day, Freeman and I used a combination of gondolas and hiking to get up to Talgar Pass at 3200m, just outside the city. Later we had an amazing dinner at a Georgian restaurant. Cause also, Georgian.

Talgar Pass, 3200m

The second and third days we went sightseeing around Almaty. In the Green Market we browsed all manner of essentials including fruit displays from Mars, sacks of rust-colored spices, butt-pad underwear, and a vibrant expanse of fermented Korean goods stretching off nearly to Korea. We spent some time wandering “the area of cheap goods from China, which are the same everywhere,” according to Freeman, who was our only expert in this situation.

One of the most interesting things about Almaty is the mash up of quaint, European-like streets lined with chic cafes and flower gardens, combined with austere Soviet-era concrete fortresses dotted throughout the city: apartments, offices and municipal buildings. On one hand, Kazakhs have enacted such delicate flourishes as distributing mountain runoff over the natural downhill slope of the entire city to create a delightful canal system that sends fresh, cooling streams of water gurgling down the sides of the manicured city lanes. On the other hand, we walked these lovely streets to get to the Central Musuem, which turns out to be housed in the Citadel of Sauron, beamed over directly from the Middle Earth.

“When the Russians build something, they go big,” Freeman explained.

Inside the Central Museum we saw two of my favorite things: mesmerizing spearheads made by prehistoric humans tens of thousand of years ago, and extremely detailed ideas on advanced cosmonogy world organization, painstakingly translated for English speakers.

I was enthralled when we visited a candy store lined with bins of billions of dazzling wrappers in every color, which, it’s candy store-ness notwithstanding, Freeman pointed out had retained a very typical Soviet-era setup, whereby customers wait in long lines while employees put goods in to containers for them. Of course, we’re talking about candy here, and an endless supply at that; under the Soviet Union, basic goods and food were often in short supply. Freeman said it was similar in China, and when he first came to the U.S. at age 11, it was incredible to him to enter a grocery store and be allowed to touch the food.

See, I never thought of that.

As I come to the end of my summer travels, I appreciated the complexity and diversity and contradictions of Almaty. At night, we tried to watch the Olympics, but Kazakh TV was only showing the things where Kazakh athletes were competing, so we attempted to be riveted by the race walking marathon – YES, A WALKING MARATHON – TRY TO STAY RIVETED – and the trampoline competition. When race-walking got to be a lot, I flipped occasionally to the BBC or CNN, where the U.S election is the only thing on, far away and too close, oddly irrelevant, and yet more relevant than ever. During the time I’ve been in Nepal this summer, there has been an onslaught of international terrorist attacks and domestic racial violence in the U.S….the other day, a friend posted a photo he captured at a Connecticut political rally (where he was protesting) proclaiming “Diversity = White Genocide.”

Mean time, Aamaa has no idea who Barack Obama is, and a major event of our summer was that I acquired some new sheets of corrugated tin to replace the 25-year-old kitchen roof, which was leaking directly into the cooking fire. How is it possible that a person can go from one side of the world to the other in barely a day?

Nepal is my full-time work, not a summer excursion. Nevertheless, during these transitions from one continent to another, I’m gifted with the chance to be between; to float over the globe and feel the intensity of tiny things, like the drops of water falling where Aamaa sits by the fire, and also the drifty arbitrariness of all of it, how the most urgent fixation somewhere is irrelevant somewhere else, how everything is swallowed in sweeping expanses of destruction and renewal and passages of time. We are so small, yet there are so many treasures to find.

Maybe that’s why my favorite stop in Kazakhstan was the Central Mosque, which we visited just after the color and chaos of the Green Market. Before we went through the gates, I draped a sheer pink shawl over my head, and while Freeman entered the cavernous men’s side, I made my way around to the smaller women’s side. I removed my shoes and entered a hushed, carpeted room just as a row of women was moving through a series of prayers playing over a speaker.

Standing in the back, I was vaguely aware of myself, a white American Jew standing aside in a Kazakh mosque, a cultural transplant who seems to be at home everywhere and nowhere. I hope these women will forgive my vanity in sharing the over-exposed photo I snapped of their meditation, because at a time with so much violence outside the walls, it was such a soft and sanctified place. The natural thing was to move to the center of the room and join in the late morning prayer, and it was easy to follow the succession of standing, bowing, kneeling, and bending to the floor. I’ve offered prayers in so many different kinds of temples and situations and settings, these fleeting spaces sometimes feel more like home than many other places where we live.

I don’t speak Arabic, of course, and I’m no more Muslim than Hindu. But with the U.S. border emerging over the horizon, CNN flashing in my head, and the world marching under us, I heard words announce themselves in my ears as I put my forehead to the ground one time and then the next, the pink shawl falling comfortingly around my face.

I’m already in the last week of my visit, and as usual things have flown by too fast. This monsoon has been more spirited than last year’s, blanketing us in torrential downpours every night and through each morning. Finally this week the weather seems to have calmed down, but I’m missing the cool and comforting feeling of the rain closing us in with its clattering and clanging.

The main focus of our summer has been a new foray into the world of health care advocacy. We have a model for rural dental medicine, and we want Nepal’s government to fund dental clinics in all of its village Health Posts. Our idea is that if the government would set a standard at which it will finance rural dental services in the national health care system, then the global development industry will start doing what we’ve doing: training, mentoring, supervising and auditing rural dental technicians so they meet the standard (which we can help define). As far as I know, we’re the only organization in Nepal working on this particular topic in this way.

Salyan Dental Clinic at the Salyan Health Post

Like many developing world countries, there’s a complicated and often mutually distrustful relationship between the aid sector and the government of Nepal. This largely results in aid agencies privatizing their projects as much as possible; I’ve done this myself, because it’s easier to just do something right yourself than manage a hassle of hectic and sometimes exploitative bureaucracy. Mean time, weak governments spin out more and more self-serving regulations against a flood of foreign funding that is trying to silo itself. Ultimately, it’s development itself that suffers, as decades-old aid industries, still chasing down base level poverty, make apparent. So something that excites me about what we’re doing now is that, setting aside dental medicine itself, I see the process we’re in, if it works, as a strong example of effective collaboration between the private sector, which is great at risk-taking, innovation, and raising money, and a developing-world government, which, at least in Nepal, is by far the best option for scale and stability. I like to think this is a version of life where we all do what we’re good at, with respect for the reality that we need everybody if we’re going to think big and get somewhere.

Now then. Should you choose to work on rights-based health care policy in the developing world, which you might have been considering, here is your primer on how to get started (after refining your particular service of choice for 10 years).

Our advocacy happens at three levels, beginning with the village level, where we’ve been pushing for permanent local government funding. This is not for the faint of heartand best suited for people with a good sense of humor. You’d better be down for a ride that’s 90% culture and 10% policy, and heavily focused on navigating relationships, social dynamics, and weather. The village level is where we’ve focused most in the past, so we’re reasonably adept at this…except that the reality is that institutional services just aren’t very stable at this level.

Next is the district government, where we’ve previously had only very simplistic coordination, such as required letters to required people. But it’s the district government that sanctions and distributes village budgets, so without support here, it’s a lot harder to get anywhere at the local level. The other day we had a District Coordination Meeting where our program director and I presented (in Nepali!) on the role of the government in extending our oral health care model to its predominately rural population, filling a gaping hole in the primary health care system. This meeting exceeded our expectations – we received a lot of positive feedback and useful criticism. I was lavishly complemented, of course, on my village accent.

Lastly, the day before I leave Nepal, we’ll have our first workshop at the central level in Kathmandu, and with this, we’re leaping in to completely new territory. But this is ultimately where it’s at: it’s the central government that fixes funding priorities and distributes earmarked budgets through the national health care system. Recognition of our model at this level would set up a standardized place for rural technicians in Health Posts, providing a framework for agencies with a lot more money to invest in creating rural dental technicians who can then be permanently staffed by Nepal’s own government.

We’re feeling emboldened and encouraged after learning a lot from each and every meeting we’ve had so far. Despite my own resistance in the past to clunky public systems, at this stage of the game, I’m finding some of the cumbersome government procedures to be oddly reassuring. They give us steps to take. We’ve met some very decent and hardworking public officials over the summer, even if they receive us with skepticism and give us some hard knocks. I think this has actually grown our confidence. We can wait for the meetings, answer the questions, submit the documents, do all the things, because we have confidence in our product. There’s also the humbling reality that the government has plenty of reasons to be cynical of the social work sector, so if we have to prove ourselves, that’s fair. It’s forcing us to be both meticulous and more adaptable…eventually, we’re responsible for creating our own good luck.

Besides that, rice planting season concludes with a wonderful festival where everyone puts on green bangles and paints their hands with henna. Kaskikot’s premier henna-drawer has become none other than yours truly. What did you expect with an activity where people let you doodle on them with temporarily-staining plants?! Govinda’s porch had an hour long wait for these skillz on Saun 1.

The best thing about the henna designs is that you start with an idea, and then it becomes a meditation that designs itself, following a pattern in the creases and borders of someone’s palm, incorporating smudges and wayward marks in to unexpected flowers and vines. You just can’t say before you start exactly what you’re gonna make.

Over the course of 13 years in Nepal, I’ve spent almost all my time in villages. My whole understanding of Nepal, and all my friends, routines, the food I eat, the places I sleep, even the way I speak the language and therefore the way I think, have been organized around my adopted family and rural life, or its popular sister, the cramped and thankless circumstance of recent urban migration.

But this summer, I’m full-time supervising a city-based office with four people and a field staff of 16; getting a latte each morning; diving in to health care policy and human rights frameworks. I schedule coffee meetings and visit offices. All told, it’s only in the last 1-2 years that I’ve started getting to know some of the other long-term foreigners and NGO founders living in Pokhara, who all pretty much know each other, because they all live in the city, which for me has always been just a place to visit for work. And when I’m here, my non-work life is completely centered around my (recent urban migrant) Nepali family.

There’s a vague sense of discovery about this new routine. For example, I’ve been sleeping in a room in the office, and – this is going to sound weird, but – slowly realizing I can put things there to make the bed and little space around it mine. Like: a new blanket. Or: a hook on the wall. This is an especially weird feeling. In all the time I’ve lived in Nepal, the only space that’s been mine-ish is the small house in Kaski, with its two beds and one dresser that I share with the rest of the family. A single bed and little shelf of clothes for me alone, that I can modify to my liking, is a bizarre amount of freedom that I’m only even noticing bit by bit. (Mind you, we’re talking about a bed in the finance and admin room of our office.)

Obviously, I have no trouble with this in the rest of my life. But in Nepal, well, it’s just not the way I’ve learned exist here.

The other night, I had Pascal and Aidan for a sleepover at the office, with its main attraction, the Internet. We watched movies and ate treats. We’ve also been out for boating and out for dinner, because it’s fun, and we live in the city. And yet these are activities that have never remotely crossed my mind in the past, because they are more similar to how I live in the U.S. It actually never occurred to me I could do them here because the communities I spend my time with mostly don’t.

Today I went to a salon and got my hair done. A salon.

When I was a kid, I was literally the pickiest eater the world has ever seen. I know you think your kid is pickier, but trust me on this one. I was okay with a short list of simple foods, and I would gladly sit and watch everyone else eat rather than be forced to alter this known quantity. Once, I went to my best friend Katie Schultz’s house, and they made me pasta with butter while the rest of the family enjoyed a normal meal. It wasn’t till I put the pasta in my mouth and a terrifying and unfamiliar taste exploded on my tongue, that I found out that butter doesn’t taste like margarine, which is what we had in my house. The feeling of shame and fear sitting at the dinner table, hoping nobody would notice if I didn’t eat, is still with me almost 30 years later.

It wasn’t until eighth grade, on a school trip to Smith Island where I was stuck in an adolescent group eating situation, that I tried tomato sauce for the first time. For a few years – ok, until college – I’d put a little blob of tomato sauce on the side of my plate, and kind of dip my fork in it. Eventually I worked my way up to normal pasta, but to this very day, when I make my own meals, every component sits side by side so I can mix as I go. I’m no longer alarmed by new foods like I was as a child, but I don’t adventure much. I eat the same reliable items almost every day.

What, you ask, does this have to do with Nepal?

I’m not sure, but all I can say is it kind of feels the same. I’ve spent a long time in this environment adjusting to the absence of almost everything I was accustomed to before I came. I found my nook and I’m comfortable there. Rural life in particular, while not materially complex, runs miles deep, and each iteration, each day, each season and year, enriches and returns itself to the last one with a sense of familiarity and certainty: the next one will come too, even if we are not here to see it. I haven’t made a life of travel. I plopped down in one place and snuggled in. Altering its fundamentals even in small ways creates a whole orchestra of funny tastes on my tongue.

Also, FYI, we eat the exact same thing for every meal in this country. PHEW.

Mean time, I do like this blanket though. How do you like my office nook?